Procurement & Payment Services

Property Removal Request

The bearer is granted permission to remove the property described below from the The College at Brockport. The bearer is responsible and liable for the return of the property in the same condition as when it left the campus. This authorization form should be retained as proof of permission to remove said item(s), and must be produced, along with proper identification, if so requested by an officer of University Police, or another employee of the College.

Name of Employee:
Faculty/Division:

Building: Room No.:
Campus Phone No.:

The authorization is valid from the removal date listed below until the Commencement date for the same academic year.
A new authorization must be issued after the expiration date.

Property Removal Date: Property Return Date:

Justification for Removal:

Destination/Location Where Property Will Be Moved

Item(s) to Be Removed:

Asset/Decal# Description, Manufacturer, Model, Serial #

SIGNATURE: DATE:

DEPARTMENT HEAD: DATE:

VICE PRESIDENT: DATE:

Property Returned in Good Condition On:

Received By: ( Department Head)

Please print and submit to Property Control, Facilities and Planning Office